n 1992, Brugada et al described 8 cases of aborted sudden death in patients without demonstrable structural heart disease, but with a peculiar electrocardiogram (ECG) pattern consisting of right bundle-branch block (RBBB) and ST-segment elevation in leads V1 to V3. 1 Three of 8 patients in this report were children, and familial occurrence was recognized. Since then, a few case reports have been published on this syndrome in young populations. [2][3][4] Brugada syndrome may cause sudden death in children, even in the first few months of life where it may be misdiagnosed as sudden infant death syndrome. The Brugada-type ECG is not rare in the adult Japanese population (0.14 to 0.70%). [5][6][7] However, the prevalence of this type of ECG in schoolchildren remains unclear. We evaluated the prevalence of Brugada-type ECG, incomplete RBBB (IRBBB) and complete RBBB (CRBBB) in Japanese schoolchildren stratified according to age. Circulation Journal Vol.68, April 2004 Methods ECG DefinitionsAll ECGs were recorded at standard gain (1 mV/10 mm) and paper speed (25 mm/s). An ECG was considered to be Brugada-type when the 12-lead ECG fully met the criteria for the Brugada syndrome as recently published in a consensus report. 8 To compare the prevalence with previous reports of healthy populations, we defined "Brugada-like" ECG as follows. The 12-lead ECG showed RBBB (rsR' or Rsr' pattern in V1 lead) and ST-segment elevation in the right precordial leads. The ST-segment elevation was defined as an elevation of the J point of ≥0.1 mV in leads V1 through V3. According to the configuration, ST-segment elevations were designated as either coved or saddle-back.Complete RBBB was defined as a QRS duration ≥0.12 s, with an RsR' configuration and IRBBB was defined as a QRS duration <0.12 s, with an rSr' configuration in the right precordial leads.The ECG records of all study subjects were reviewed by Yamakawa, without any information about the subjects including age, sex, or family history of sudden death. Ishikawa and Sumita reviewed those records on which judgments had been made, and they concurred with the judgments. Study SubjectsThe study population consisted of 20,387 young We considered right bundle-branch block and ST-segment elevation of the J point of ≥0.1 mV in leads V1 through V3 as Brugada-like ECG, and an ECG was considered to be Brugada-type when the 12-lead ECG fully meet the criteria for the Brugada syndrome as recently published in a consensus report. Only 2 children (0.0098%, 95% confidence interval (CI): 0 to 0.023%) completely conformed to the criteria for Brugada-type ECG. Brugada-like ECG was found in 11 (10 male) of 20,387 children (0.054%, 95% CI: 0.022 to 0.086%). The prevalence in males was significantly higher than that in females, even in children (0.096% vs 0.010%, p=0.012). Stratified according to age, there was tendency for the prevalence of Brugada-like ECG to increase up to puberty (first graders, 0.01%; fourth graders, 0.05%; seventh graders, 0.08%; tenth graders, 0.23%; p=0.068). ConclusionThe pre...

large, multicenter study reported that the incidence of unintentional failure to hospitalize patients presenting at the emergency department with acute myocardial infarction (AMI) or unstable angina pectoris (UA) was low, although possibly associated with a poor outcome, and it was suggested that the incidence of missed diagnoses of acute cardiac ischemia in the emergency department could be reduced by using a new imaging modality.Recently, the clinical usefulness of a perfusion tracer in the diagnosis of acute coronary syndromes (ACS) was reported. [1][2][3][4] Rest myocardial perfusion imaging with 99m Tc sestamibi had a high sensitivity for identifying patients with ACS 1 and the sensitivity of 99m Tc perfusion tracer and 201 TlCl imaging for detecting coronary artery lesions ranged from 82% to 95% and from 80% to 84%, respecCirculation Journal Vol. 68, November 2004 tively, with a specificity of 75-100% and 75-82%. [2][3][4] 123 I--methyl-p-iodephenyl-pentadecanoic acid (BMIPP) single photon emission computed tomography (SPECT) imaging is considered suitable for patients with UA or severe coronary artery disease because it does not require a provocative test and thus would be useful for detecting the culprit lesion in patients with ACS. 5,6 This imaging modality represents the lesions as ischemic memory. 7 99m Tc-pyrophosphate (PYP) also uses a flow tracer to assess the severity and extent of ischemia, and that of myocardial viability. In UA the uptake of PYP is visualized as diffuse, slightly positive findings 8-10 and others have suggested that there is uptake of this agent by injured myocardial cells in the absence of infarction. 11,12 Preliminary clinical results suggest that breath-held, black blood turbo short-inversion-time inversion recovery (STIR) imaging may be sensitive to focal changes of contrast between edematous and normal myocardium. 13 In the present study we investigated the clinical significance of PYP, BMIPP, 201 TlCl and T2-weighted inversion -recovery magnetic resonance imaging (MRI) for detecting the culprit lesions in patients with ACS. Katumi Matumoto, MD*; Youhei Yamakawa, MD*; Satosi Umemura, MD* Background The incidence of missed diagnoses of acute cardiac ischemia in the emergency department could be reduced by a new imaging modality. In the present study, the clinical significance of 99m Tc-pyrophosphate (PYP), 123 I--methyl-p-iodephenyl-pentadecanoic acid (BMIPP), 201 TlCl scintigraphy (imaging) and T2-weighted inversion -recovery magnetic resonance imaging (MRI) for the detection of culprit lesion in patients with acute coronary syndromes (ACS) was compared. Methods and ResultsThe study group comprised 18 patients with ACS: 12 patients with acute myocardial infarction (AMI) (11 males; mean age, 63±11 years) and 6 patients with unstable angina (UA) (3 males, mean age, 67±5 years). Of the 12 patients with AMI, 10 underwent 201 TlCl and PYP single photon emission computed tomography (SPECT) studies as a dual-energy acquisition ( 201 TlCl/PYP) and 8 underwent 201 TlCl SPECT w...

This imaging approach allows accurate evaluation of myocardial viability. Furthermore, the high correlations of gated FDG PET and gated MIBI SPECT measurements hold promise for the assessment of left ventricular function using gated FDG PET.

Circ J 2009; 73: 654 -657 t is important to set the optimal atrioventricular (AV) delay to achieve optimal AV synchrony in patients with an implanted DDD pacemaker. [1][2][3][4][5][6] The optimal AV delay allows completion of end-diastolic filling flow prior to ventricular contraction, providing the longest diastolic filling time, consequently increasing cardiac output and reducing the pulmonary wedge pressure. To determine the optimal AV delay, pulsed Doppler echocardiography is commonly used, 4 and our method was reported previously. 5,[7][8][9][10][11][12][13] However, echocardiography has several problems. The examination is time-consuming, and the optimal AV delay varies from patient to patient and with the patient's heart rate during exercise, sleep and other activities. Therefore, although the optimal AV delay is set using echocardiography only once, that value may not be adequate in the patient's daily life. If a more simple method of assessing the optimal AV delay was available, the delay could be set more frequently. Therefore, the aim of this study was to predict the optimal AV delay by a novel method using phonocardiography. Methods Study PopulationWe included 6 patients (mean age 72.7±5.7 [SD] years, 3 males) with complete AV block, normal left ventricular (LV) function and an implanted DDD pacemaker (Table). Informed consent was given by each participant before enrollment in this study. Study ProtocolThe amplitude of the first heart sound (S1) was recorded on a phonocardiogram (PCG) during AV sequential pacing. Transmitral flow and the time velocity integral (TVI) of the LV outflow tract (LVOT) were measured by pulsed Doppler echocardiography at the same time. The AV delay was set from 50 to 250 ms in a stepwise fashion at 20-or 25-ms increments. The pacing rate was fixed at 70-80 beats/min to maintain atrial and ventricular pacing. All patients were examined at rest in the left lateral decubitus position, at the end of each 5-min period of AV sequential pacing. Measurement of S1An acceleration-type PCG microphone (MA-250, Fukuda Denshi, Tokyo, Japan) was positioned at the cardiac apex and connected to an echocardiograph. Phonocardiograms were filtered from 20 to 600 Hz and recorded on the echocardiograph. The S1 amplitude from peak to peak was measured. The acceleration-type PCG microphone converts the vibration of chest by the heartbeat to electrical signals according to acceleration. There was little PCG noises and (Received April 16, 2008; revised manuscript received November 14, 2008; accepted December 7, 2008; released online February 26, 2009 Background: The optimal atrioventricular (AV) delay setting is important for achieving optimal AV synchrony in patients with an implanted DDD pacemaker. Using pulsed Doppler echocardiography is the most common method of predicting the optimal AV delay, but it is a complicated and time-consuming method. Therefore, an automatic optimizing function of the AV delay at different atrial rates is desirable for achieving a favorable hemodynamic state. This...

We investigated whether anti-tachycardia therapy might improve the altered cardiac adrenergic and systolic function in tachycardia-induced cardiomyopathy (TC) in contrast to dilated cardiomyopathy (DCM). The subjects were 23 patients with heart failure, consisting of 8 patients with TC (43.6 +/- 10.0 yrs) and 15 with DCM (45.3 +/- 8.2 yrs). TC was determined as impairment of left ventricular function secondary to chronic or very frequent arrhythmia during more than 10% of the day. All patients were receiving anti-tachycardia treatment. Cardiac 123I-MIBG uptake was assessed as the heart/mediastinum activity ratio (H/M) before and after treatment. LVEF was also assessed. In the baseline study, H/M and LVEF showed no difference between TC and DCM (2.21 +/- 0.44 vs. 2.10 +/- 0.42, 35.3 +/- 13.1 vs. 36.0 +/- 10.9%, respectively). After treatment, the degree of change in H/M and LVEF differed significantly (0.41 +/- 0.34 vs. 0.08 +/- 0.20, 20.5 +/- 14.4 vs. -2.1 +/- 9.6%, p < 0.01). In TC, heart failure improved after a shorter duration of treatment (p < 0.05). In conclusion, anti-tachycardia therapy can improve altered cardiac adrenergic function and systolic function in patients with TC over a shorter period than in those with DCM.